Skip to main content

Advertisement

SpringerLink
Log in

Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality.

OBJECTIVE: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later.

DESIGN: Prospective observational cohort study.

SETTING: Three university hospitals.

PARTICIPANTS: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up.

MEASUREMENTS: We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months. We used χ 2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI<10 at hospitalization and 3 months); remittent depressed (BDI ≥10 at hospitalization; <10 at 3 months); and persistently depressed patients (BDI ≥10 at hospitalization and 3 months).

RESULTS: Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients.

CONCLUSIONS: Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lane D, Carroll D, Ring C, Beevers DG, Lip GY. The prevalence and persistence of depression and anxiety following myocardial infarction. Br J Health Psychol. 2002;7:11–21.

    Article  PubMed  Google Scholar 

  2. Lesperance F, Frasure-Smith N, Juneau M, Theroux P. Depression and 1-year prognosis in unstable angina. Arch Intern Med. 2000;160:1354–60.

    Article  PubMed  CAS  Google Scholar 

  3. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996;93:1976–80.

    Google Scholar 

  4. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1995;91:999–1005.

    PubMed  CAS  Google Scholar 

  5. Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001;88:337–41.

    Article  PubMed  CAS  Google Scholar 

  6. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomat Med. 2004;66:802–13.

    Article  Google Scholar 

  7. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45:637–51.

    Article  PubMed  Google Scholar 

  8. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.

    PubMed  CAS  Google Scholar 

  9. McKellar JD, Humphreys K, Piette JD. Depression increases diabetes symptoms by complicating patients’ self-care adherence. Diabetes Educ. 2004;30:485–92.

    PubMed  Google Scholar 

  10. Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry. 2003;25:246–52.

    Article  PubMed  Google Scholar 

  11. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.

    Article  PubMed  CAS  Google Scholar 

  12. Park H, Hong Y, Lee H, Ha E, Sung Y. Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care. J Clin Epidemiol. 2004;57:978–84.

    Article  PubMed  Google Scholar 

  13. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27:2154–60.

    Article  PubMed  Google Scholar 

  14. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P. Depressive symptoms are associated with unhealthy lifestyles in hypertensive patients with the metabolic syndrome. J Hypertens. 2005;23:611–7.

    Article  PubMed  CAS  Google Scholar 

  15. Ammassari A, Antinori A, Aloisi MS, et al. Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics. 2004;45:394–402.

    Article  PubMed  Google Scholar 

  16. Carney RM, Freedland KE, Eisen SA, Rich MW, Jaffe AS. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol. 1995;14:88–90.

    Article  PubMed  Google Scholar 

  17. Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Predictors of attendance at cardiac rehabilitation after myocardial infarction. J Psychosomat Res. 2001;51:497–501.

    Article  CAS  Google Scholar 

  18. Grace SL, Abbey SE, Pinto R, Shnek ZM, Irvine J, Stewart DE. Longitudinal course of depressive symptomatology after a cardiac event: effects of gender and cardiac rehabilitation. Psychosomat Med. 2005;67:52–58.

    Article  Google Scholar 

  19. Brummett BH, Babyak MA, Siegler IC, Mark DB, Williams RB, Barefoot JC. Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease. Am J Cardiol. 2003;92:529–32.

    Article  PubMed  Google Scholar 

  20. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis. 2005;178:339–44.

    Article  PubMed  CAS  Google Scholar 

  21. Ziegelstein RC, Fauerbach JA, Stevens SS, Romanelli J, Richter DP, Bush DE. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000;160:1818–23.

    Article  PubMed  CAS  Google Scholar 

  22. Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosomat Res. 2002;53:897–902.

    Article  Google Scholar 

  23. Lett HS, Blumenthal JA, Babyak MA, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosomat Med. 2004;66:305–15.

    Article  Google Scholar 

  24. Schleifer SJ, Macari-Hinson MM, Coyle DA, et al. The nature and course of depression following myocardial infarction. Arch Intern Med. 1989;149:1785–9.

    Article  PubMed  CAS  Google Scholar 

  25. Lauzon C, Beck CA, Huynh T, et al. Depression and prognosis following hospital admission because of acute myocardial infarction. Can Med Assoc J. 2003;168:547–52.

    Google Scholar 

  26. Lesperance F, Frasure-Smith N, Talajic M, Bourassa MG. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation. 2002;105:1049–53.

    Article  PubMed  Google Scholar 

  27. Bush DE, Ziegelstein RC, Patel UV, et al. Post-myocardial infarction depression. Evid Rep Tech Assess [Summ]. 2005;123:1–8.

    Google Scholar 

  28. Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonto, TX: Psychological Corporation; 1993.

    Google Scholar 

  29. Strik JJ, Hong A, Lousberg R, Denollet J. Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics. 2001;42:423–8.

    Article  PubMed  CAS  Google Scholar 

  30. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  31. Pignone M, Rihal CS, Bazian Ltd. Secondary prevention of ischaemic cardiac events. Clin Evid. 2004;12:193–235.

    Google Scholar 

  32. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.

    Article  PubMed  CAS  Google Scholar 

  33. Shalansky SJ, Levy AR. Effect of number of medications on cardiovascular therapy adherence. Ann Pharmacother. 2002;36:1532–9.

    Article  PubMed  Google Scholar 

  34. Morgado A, Raoux N, Jourdain G, Lecrubier Y, Widlocher D. Over-reporting of maladjustment by depressed subjects: findings from retesting after recovery. Soc Psychiatry Psychiatr Epidemiol. 1991;26:68–74.

    Article  PubMed  CAS  Google Scholar 

  35. Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev. 1989;96:234–54.

    Article  PubMed  CAS  Google Scholar 

  36. EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries: principal results from EUROASPIRE II euro heart survey programme. Eur Heart J. 2001;22:554–72.

    Article  Google Scholar 

  37. Eagle KA, Kline-Rogers E, Goodman SG, et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: An Ongoing Prospective, Observational Study. Am J Med. 2004;117:73–81.

    Article  PubMed  Google Scholar 

  38. DiMatteo MR, Giordain PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794–811.

    Article  PubMed  Google Scholar 

  39. Horwitz RI, Viscoli CM, Berkman L, et al. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990;336:542–5.

    Article  PubMed  CAS  Google Scholar 

  40. Rosen MI, Rigsby MO, Salahi JT, Ryan CE, Cramer JA. Electronic monitoring and counseling to improve medication adherence. Behav Res Ther. 2004;42:409–22.

    Article  PubMed  Google Scholar 

  41. Yun LW, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005;38:432–8.

    Article  PubMed  CAS  Google Scholar 

  42. Katon WJ, Von Korff M, Lin EH, et al. The pathways study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.

    Article  PubMed  Google Scholar 

  43. Lustman PJ, Griffith LS, Freedland KE, Kissel SS, Clouse RE. Cognitive behavior therapy for depression in type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med. 1998;129:613–21.

    PubMed  CAS  Google Scholar 

  44. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005;28(suppl 1):S4-S36.

    Article  Google Scholar 

  45. Glassman AH, O’Connor CM, Califf RM. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288:701–9.

    Article  PubMed  CAS  Google Scholar 

  46. Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the enhancing recovery in coronary heart disease (ENRICHD) randomized trial. JAMA. 2004;289:3106–16.

    Google Scholar 

  47. Newman S. Engaging patients in managing their cardiovascular health. Heart. 2004;90(suppl 4):iv9-iv13, iv39–iv40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Ian M. Kronish MD & Ethan A. Halm MD, MPH

  2. Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA

    Nina Rieckmann PhD

  3. Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA

    David Vorchheimer MD, Donald C. Haas MD, MPH & Karina W. Davidson PhD

  4. Department of Medicine, Columbia University Medical Center, 622 W 168th St, PH9 Center, Room 948, 10032, New York, NY

    Daichi Shimbo MD & Karina W. Davidson PhD

Authors
  1. Ian M. Kronish MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nina Rieckmann PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ethan A. Halm MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daichi Shimbo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Vorchheimer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Donald C. Haas MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karina W. Davidson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karina W. Davidson PhD.

Additional information

No conflicts of interest to declare.

This work was financially supported by Contract HC25197, and by Grants HL076857, HL04458, and HL072866 from the National Heart, Lung, and Blood Institute, Bethesda, MD, and Grant 5D14HP00163-03-00 from the Health Resources and Services Administration, Rockville, MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kronish, I.M., Rieckmann, N., Halm, E.A. et al. Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes. J Gen Intern Med 21, 1178–1183 (2006). https://doi.org/10.1111/j.1525-1497.2006.00586.x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00586.x

Key Words

Search

Navigation